Jim’s Take

Why You Need a Medical “Boy Scout” or “Girl Scout”

Scouts are Pathfinders, Good-Deed Doers and helpful folks to have around.  Anytime you’re in unfamiliar terrain, they can come in handy.

Nowhere is that more true than medicine.  Most of us are baffled by medical jargon, often uncertain exactly what it is our doctor has told us, particularly if the news is bad.  And doctors are ever more frequently pushed to “churn” their patient load as frequently as they can.

So we ought to want to rely on a Pathfinder, a Map Reader, a Guide through the forest of medical recommendations and treatment.

Particularly On Serious Stuff

It’s not a problem if your doctor tells you you have a cold or the flu or arthritis … probably.

But for the more serious diagnoses – high blood pressure, cholesterol, prediabetes, morbid obesity or diabetes —you ought to ask for and get help.  Or for — Heaven forbid — cancer, heart disease or any of a whole Pantheon of serious diseases that will require lifestyle changes, complex medical procedures or surgery, a Guide, a Concierge can be literally a lifesaver.

Some Scary Statistics

Ponder this.  A second opinion service many larger plans use recite these chilling statistics:

  • The Institute of Medicine states that “Most Americans will encounter at least one diagnostic error in their lifetime, sometimes with severe consequences for their physical and mental health.”
  • According to the Mayo Clinic Proceedings, 26% of diagnoses were found to be incorrect!
  • The National Academy of Medicine stated that up to “1/3 of all healthcare costs are considered to be wasted,
    the bulk tied to misdiagnosis
  • A Johns Hopkins study indicated that misdiagnosis and medical error is the third leading cause of adult fatalities.

But Second Opinions are “Embarrassing”

I understand.  I have all the faith in the world in my Primary Care Doc, and I happen to believe that we need to move to a medical model that is based more completely on Primary Care as the first defense against disease.

It would be tough for me to have to look at my doctor and say, “I’d really like a second opinion.”  I’d feel that he would think that I no longer trusted him.

But that’s NOT how a good MD feels.  On the contrary, most are mostly interested in getting the best care for the patient, and since many diagnoses aren’t blindingly obvious, a second opinion reassures them.

But if you’re going to get a second opinion, the last thing you want to do is pick up the yellow pages and go “specialist shopping.”

There’s a good chance you’ll pick the wrong guy.  Likewise, while your doctor is a better source for referring you to the second opinion doctor, she generally doesn’t have access to the full background of every specialist she recommends.

She knows them from the club or medical meetings or they went to school together.  She doesn’t know about their malpractice suits, professional disciplinary actions, etc

You’d be much better off using someone with access to all that info.  For example, for surgeons, one source we use has the following criteria that they evaluate to develop their recommendations:

  • Medical experience
  • Education & training
  • Fellowships
  • Board certification
  • Surgical complications
  • Disciplinary actions
  • Malpractice issues
  • Readmission rates
  • Mortality
  • Outliers
  • Facility affiliations
  • Hospital ratings

And when they apply that to, for example, surgeons they find these kinds of numbers:

Criteria# Docs Meeting Criteria
Within Acceptable Distance60
Adequate Procedure Volume (50/year)14
Quality Outcomes8
Acceptable Costs6
High Quality Network4

That last criteria is one that meets such high standards that employers are willing to “bonus” employees to use that doctor.

The point is that by using that limited source you are able to assure yourself of the best possible outcome.

But Does It Really Make a Difference?

Yeah, Baby, it does.  There is a service that allows employees to get access to the best of the best –

  • Without having to actually have an appointment (your records are sent to them electronically)
  • A NATIONAL network of widely recognized specialists
  • Ones who WON’T be competing with your doctor to do the work – they only give a second opinion and suggest treatment & diagnosis changes.

And here’s where the proof of the pudding comes in.  Of diagnoses referred to them, these were the outcomes:

  • On average, 44% of the time, as a result of the consultation, there was a change in diagnosis.
  • And 75% of the time there was a change in the treatment plans.

But I’m the Business Owner.  Why Do I Care about Others’ Diagnoses?

Because such a service is a MONEY SAVER. If you’re self-funded on your health plan (and if you have 35 on your plan you ought to seriously, seriously think about it.  Here’s why:

  • Of Musculoskeletal Diagnoses
    • 36% saw a diagnosis change
    • 69% saw a treatment change
    • Average Savings from the changes: $16-$48,000/diagnosis.
  • Of Cancer Diagnoses
    • 11% saw a diagnosis change
    • 50% saw a treatment change
    • Average Savings from the changes: $12-$32,000/diagnosis.
  • Of Heart Disease Diagnoses
    • 27% saw a diagnosis change
    • 61% saw a treatment change
    • Average Savings from the changes: $18-$40,000/diagnosis.

You can take that to the bank – in every sense of the word.

Want more info about that, send me an email (jedholm@bbibenefits.com with the Subject Line Second Opinion and I’ll get you information about how you can use this technique to improve outcomes, make your people healthier, and add money to your bottom line!!